This editorial piece by Mental Health Coordinating Council CEO Carmel Tebbutt was published in the Sydney Morning Herald Opinion pages on 17 January 2023
New York can be a magical city to visit – ice skating at the Rockefeller Centre, carriage rides in Central Park, the art galleries and museums. But the city is also iconic for having one of the largest populations of people who are homeless.
A new push by New York Mayor Eric Adams to remove people with severe mental health conditions from the city streets, including involuntarily hospitalising people, has met with significant debate, even in a place as tough as the Big Apple. Adams recently announced that police and other city workers will be instructed to take people to hospitals who are a danger to themselves, even if they pose no risk of harm to others.
Most New Yorkers agree more needs to be done to support people who are unwell and living on the streets and in the subways and there are some plaudits for the mayor for engaging with an issue that many deem too hard. But there is also deep concern and scepticism about his approach, with mental health advocates claiming the plan infringes peoples’ rights and that police are not trained to determine who should be taken to hospital. Critics point out the need for affordable housing, the chronic shortage of hospital beds and the lack of community-based mental health services.
New York is not alone in trying to respond to a tsunami of need for community-based alternatives, following the deinstitutionalisation policies of earlier decades. Maybe they have something to learn from what is being done right here in NSW.
Mental health support packages, delivered through the Community Living Supports (CLS) and Housing and Accommodation Support Initiative (HASI) programs in NSW support people with severe mental health conditions to live and participate in the community. A recent evaluation of the programs by the Social Policy Research Centre at the University of NSW was overwhelmingly positive, finding both schemes improve outcomes for consumers, reduce hospital admissions and are cost-effective.
These are community-based programs, funded by NSW Health and delivered by community mental health organisations working in partnership with local health districts. The type of support people receive depends on their individual needs and may include assistance with daily living activities such as shopping, engaging socially and learning skills, maintaining their tenancies and accessing clinical mental health services.
The UNSW evaluation found that most consumers experienced positive outcomes and the programs helped them to better manage their mental health and increased opportunities for social inclusion. Contact with mental health services was nearly 64 per cent less if people remained in the program for more than a year and hospital admissions due to mental health decreased by 74 per cent following program entry, with the average length of stay decreasing by nearly 75 per cent over two years. Consumers with a new charge in the criminal justice system and with community correction orders dropped to almost zero in the year after they entered the program. And, significantly, the programs generate savings with a net cost saving per person of about $86,000 over five years.
These are staggering results. Too often, policymakers and politicians despair about how to improve mental health services and yet there are cost-effective programs already making a huge difference in people’s lives. The only issue is that not enough people can access them.
As a former health minister, I understand all too well the pressures on the health budget – an ageing population, the increasing burden of chronic disease, the cost of sophisticated medical technology, and of course, the ongoing impact of COVID-19. But other states are exploring innovative solutions, with both Victoria and Queensland introducing new payroll levies to fund the desperate need for mental health services in their states. NSW should consider doing the same.
An additional investment of only $356 million over four years would support a further 10,000 people with severe mental health conditions to live well in the community. What’s more, according to KPMG research, the savings per person would be almost double the cost of the programs over the four years.
While it’s not yet as bad as New York, we are seeing more and more people on our streets living with mental distress. Surely, it is time to increase investments in programs we know work before we find the problem has grown beyond a solution.